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Peter Harbage

This week, we join many people who work in health policy in California and across the country in grieving over the passing of our friend and colleague Peter Harbage. For two decades, Peter has been on the front lines of the work to improve our health system, working as a administrator, a consultant, a policy guru, an evangelist, a thinker, a party host and provider of social lubricant, and an unsung architect of national health reform.

Recently, Peter was running Harbage Consulting with his wife Hilary, managing a growing team of experts on the financing of safety-net providers with clients nationwide, but including working with the California Department of Health Care Services on everything from the Medicaid waiver to the shift of seniors and people with disabilities to managed care. But that doesn’t begin to describe Peter’s role personally or professionally.

Peter worked for two decades on health reform at the federal, state and local level, starting his career at the US Department of Health and Human Services as a Medicaid budget analyst, and also serving as an Assistant Secretary for Health at the California Health and Human Services Agency under Governor Gray Davis, and as a Special Assistant to the Administrator of the federal Health Care Financing Administration under the Clinton Administration. (He started in the Clinton Administration as a White House intern at the same time I did, we learned years later.)

Most notably, Peter became one of the main architects of the health reform ideas that shaped the Affordable Care Act. From 2003 to 2008, Peter served as the senior health policy advisor to presidential candidate and former Senator John Edwards–the campaign that was first to put out a ambitious and comprehensive health reform plan, soon to be followed (perhaps prompting, certainly giving political cover and space for) similarly structured reform proposals by Senators Clinton and Obama. In 2007, he worked extensively with Governor Arnold Schwarzenegger’s health care reform team in California in his role at the New America Foundation. Most recently, Peter was a Fellow at the Center for American Progress. In these roles, Peter helped develop and promote the “individual mandate” concept, and helped detail the “hidden tax” that patients pay when we have so many uninsured.

The irony at the time was that the individual mandate was the conservative “individual responsibility” idea that was originally opposed by progressive and patient advocates like me for being punitive, without the needed consumer protections to make it workable. Peter helped develop the idea to its logical conclusion, making it as much a mandate on government to ensure that coverage is affordable, available, adequate, and administratively simple. Even when we disagreed, I knew he was committed to making progress for patients and the uninsured. Peter has made a tangible difference in the historic effort to reform our health system for the better, whether in this early development or in his significant work during the Congressional debate over the ACA or during its implementation in states around the country, including his work on delivery system reform through California’s Medicaid waiver.

But I’ll miss him also because he was a good friend to the organization, and to me. Personally, I’ll miss the chats of him stopping by our office to talk over a policy idea or three, or hanging out with him and his lovely wife Hilary after a panel or conference or at a ballgame. After a health policy conference in Sacramento or DC, he was always eager to host the after-party–enough so there is a drink named after him at The Grange, a restaurant a few blocks from the California Capitol. I have on my bulletin board an autographed list of specialty drinks from at least one such Harbage-sponsored occasion, with names like the “public option” and other wonky terms. That was his way, to be friendly and open and try to connect people socially as well as professionally, all in an easy going style. His wedding at a Napa winery had enough health policy muckety-mucks in attendance that I joked with him if I should have brought handouts. Beyond advancing key ideas and helping implement policies to connect people to care, Peter helped build a community, of which I am happy to have been a part.

You don’t have to be his age (as I am) to think he was taken way too young, and that he had so much more to contribute: More health reforms to invest and implement, more parties to plan. It’s a credit to Peter that his passing is a loss not just for those who knew him, but likely for Californians and others he has never met.